Aspirin in primary prevention: New meta-analysis

Posted by: admin on: December 8, 2011

Asprin is the drug we invariably use for all cardiac patients to prevent cerebrovascular accidents. Here is something to show that clinical trials are not sufficient enough to prove its undoubted benefits.


A new meta-analysis of studies of aspirin in primary prevention in a total of 90 000 subjects has suggested a 14% reduction in total cardiovascular events (driven by a 19% reduction in nonfatal MI) and a non-significant reduction in overall mortality and stroke.

But clinical-trials guru Dr Sanjay Kaul (Cedars Sinai Medical Center, Los Angeles, CA) says “The key finding of this meta-analysis is that aspirin use is associated with a statistically significant reduction in nonfatal MI. However, the clinical significance of this finding is not clear, as annualized risk difference or the number-needed-to-treat data are not presented.
It is also not clear whether the data analysis included silent MIs identified on ECG examination.

For guiding clinical practice, an estimate of benefit/risk is necessary, which these data don’t provide. In addition to significant statistical heterogeneity, there is also clinical heterogeneity (in aspirin dose, treatment duration, concomitant medications, etc) that might impact interpretation of the data. Lack of patient-level data precludes adjustment for variability in critical prognostic covariates and does not permit the more robust time-to-event analysis.”


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